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Dental Office
Tomas J. Barrios DDS
Associate Clinical Professor of
Oral & Maxillofacial Surgery,
St. Josephs Regional Medical Center,
Jersey City Medical Center
• Prevention & Preparation
• Syncope
• Hypoglycemia
• Epileptic episode
• Angina
• Myocardial infarct
• Anesthetic overdose
• Drug allergy anaphylaxis
• Asthma
Prevention & Preparation
• Supine position
• 100 % Oxygen
• Evaluate Airway, breathing , circulation
• Vitals
Emergency management &
resuscitation plan
• Primary survey • Secondary survey
1. ABCDE 1. Head to toe by region
2. Purpose : Identify & exam
treat life threatening 2. Purpose : Identify &
problems treat life threatening
3. History problems
4. Resuscitation measures 3. History : data gathering
are instituted 4. System specific test
5. Re evaluation: repeat
surveys untill cause is
identified
6. Definitive care
Vitals, Clinical signs and
symptoms of potential illness
Tenets of primary survey
• Proceed rapidly
• Err on the side of aggressiveness
• When in doubt “do”
• Stay in sequence
• Know what to look for , recognize and treat
• Look for likely, treatable problems
• Make decisions based on direct examination
• Initiate only simple test and procedures
Generalized treatment protocol
Documentation
Anxiety attacks
hyperventilation syndrome
MI
Hypoglycemia
Epilepsy
Hypotension
Clinical manifestation presyncopal
• Early • Late
Nausea Hypotension
Warmth Bradycardia
Perspiration Hyperpnea
loss of color Pupillary dilation
Baseline Blood press Peripheral coldness
Tachycardia Visual disturbance
Loss of consciousness
Syncopal phase
• Hemoglobin A1C
• Fructosamine
• Home monitoring
How are patients going to become
hypoglycemic ?
• Too much insulin
• Alcohol consumption
• Excessive exercise
• Missed delayed meals
• Reduced meals
• Medication error
• Other illness
Symptoms
• Autonomic • Neuroglycopenic
1. Sweating 1. Dizziness
2. Trembling 2. Confusion
3. Palpitations 3. Difficulty speaking
4. Anxiety 4. Headache
5. Nausea 5. Inability to concentrate
6. Weakness
7. Blurred vision
Treatment
Alternative TX
• Glucose tablets
• 4 teaspoons of sugar in water
• 5 oz of regular soft drink
• Orange juice
• Lethargy
• Disorientation
• Apnea, obstructed airway
• Cardiac arrhythmias
• Evaluate patient injury
Chest pain
• Angina : Latin for spasmodic , choking or
suffocating pain
• Pectoris :Latin for chest
Differential Diagnosis
• Angina
• Myocardial infarction
• Dyspepsia, GERD
• Musculoskeletal
• Pulmonary embolus
• Spontaneous pneumothorax
• Aortic dissection
• Esophageal rupture
• Panic disorder
Relevant factors
• Onset : time, associated
event
• Location
• Radiation absence or site
• Type of pain: deep
visceral, superficial,
pleuritic
• Exacerbating or
alleviating factors
What occurs ?
• Increased Myocardial Demand
1. Elevated heart rate
2. Elevated BP
3. Elevated endogenous catecholamines
• ABC
• Oxygen
• Vitals
• EMS
• Monitor seizures
• Monitor respiration
• Cardiac monitor
Drug interactions
Vasoconstrictor interactions
Treatment
• ABC
• Patient comfort
• Vitals
• EMS
• Reassurance reaction will pass
• If BP becomes >170 systolic consider
nitroglycerin
Methemoglobinemia
• ABC
• Oxygen
• EMS
• Monitor patient vitals , Cardiac
• Most healthy adults drugs and metabolites
are eliminated
• Methylene blue 1-2 mg/kg IV
Airway
Allergy
Obstruction
Asthma
Hyperventilation
Allergy and anaphylaxis
Drug allergy & Anaphylaxis
• ABC
• Establish reaction type
• Activate EMS
• IV access
Medications for treatment
Minor reactions
Anaphylaxis
Management of allergic scenarios
Medications
• Diphenhydramine 50 mg IM , IV
• Epinephrine: .3ml 1/1000 ( 0.3mg )
• Dexamethasone : 20 mg IM , IV
Obstructed airway
Etiology
• Terminate therapy
• Position patient
• Administer B agonist spray Albuterol
• Oxygen
• EMS
• Epinephrine SC or IM 0.3ml ( 1/1000
dilution) Epipen
Hyperventilation
• Usually a patient which suffers from:
panic, phobias, psychiatric disorder
• Reassurance
• Slow down breathing
• Comfortable position
• Remove any visual stimuli
• Vitals
• Full rebreathing bag
• Anxiolytic meds , Diazepam ?
Bibliography